Evaluating the Impact of Visiting Services in Rural and Remote Regions

Evaluating the Impact of Visiting Services in Rural and Remote Regions

There are significant health disadvantages for residents of rural and remote locations, both in Australia and throughout the world. Rural and remote populations of geographically large, high-income countries, such as Australia, experience major inequalities in service provision and resource distribution. The outcome of which can be seen in the subsequent inequitable health and well-being of these populations when compared to those living closer to major cities. Despite reforms in Australia, the current health system continues to be focused on specialised acute care in major metropolitan centers as opposed to redirecting resources to provide preventative care, population health initiatives and high-quality primary care across the country. Evidence suggests that Australia's most significant health workforce issues is not one of total supply but of distribution including inadequate service provision to residents of rural and remote areas. Visiting primary care services operate to reduce disparities in access and outcome for residents of rural and remote areas. The published literature pertaining to visiting primary care services is sparse and inconsistent, particularly that describing the assessment of impact, and evaluation of service types. The current research aims to progress the limited literature available through three studies. The first study was a systematic quantitative literature review to assess and consolidate the published literature concerning visiting services and to quantify the gaps in evidence requiring further investigation. The output of the first study was a quantitative database with categorised information extracted from each study that can be added to with future publications. The second study was a Delphi method, used to assess the credibility and confirmability of a proposed conceptual framework: the seven principles for effective visiting services. A heterogenous panel of 13 experts in rural and remote health care participated in three iterative, online survey rounds critiquing the model. The output of the second study was a revised model of seven principles for effective visiting services, reflecting four changes compared to the original, which received unanimous endorsement from panel members. The third study used the case study method to assess the clinical utility of the revised model. Outback Futures, a visiting allied health service operating from Brisbane, Australia, was selected as the case and executives from the organisation participated in four group interviews. The results of the case study were evidence for the clinical utility of the revised model as well as a protocol self-assessment framework to guide organisation's evaluation of practice. Further, three themes were identified from the interviews, relationship is fundamental, importance of co-design, and, being effective as a visiting service is challenging. The three studies reported in this thesis collectively represent a significant contribution to the literature and have implications for health policy, funding, visiting service organisations, and the residents of rural and remote areas themselves.

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